Provider Demographics
NPI:1962013060
Name:GENTLE DENTAL SPA PLLC
Entity Type:Organization
Organization Name:GENTLE DENTAL SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-809-4865
Mailing Address - Street 1:1261 W GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-8348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:735 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-2840
Practice Address - Country:US
Practice Address - Phone:361-883-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty